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免疫功能低下患者的诊断与治疗挑战:一名中性粒细胞减少的急性髓系白血病患者的病例研究

Diagnosis and Treatment Challenges of in Immunocompromised Patients: A Case Study in a Neutropenic AML Patient.

作者信息

Modi Dhruvi, Dessureault Sophie, Greene John

机构信息

Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India.

GI Tumor Program Moffitt Cancer Center and Department of Oncologic Sciences University of South Florida Morsani College of Medicine, Tampa, Florida, USA.

出版信息

Case Rep Infect Dis. 2024 Jul 22;2024:7806235. doi: 10.1155/2024/7806235. eCollection 2024.

Abstract

Although fungal infections causing intestinal perforation and necrosis are rare, they can be particularly dangerous in immunosuppressed patients, often leading to increased mortality rates and poor prognoses. Candida species are typically surface fungi, but in patients with compromised immune systems, they can invade the small intestine and cause angioinvasive infections. A case study involving a 30-year-old female with acute myeloid leukemia (AML) illustrates this phenomenon. The patient was presented with symptoms of abdominal pain, fever, diarrhea, recurrent episodes of intestinal necrosis, hematomas due to thrombocytopenia, and subsequent postoperative enterocutaneous fistulas. Extensive testing ruled out other possible causes of intestinal necrosis and enteritis, including Crohn's and CMV diseases. was ultimately identified in blood cultures from the periphery, peritoneal fluid, and intestinal biopsy of respected sections, indicating that it was responsible for intestinal invasion and necrosis. The patient was then treated with amphotericin B, cefepime, and metronidazole. This case highlights the potential severity of fungal infections in immunosuppressed patients, particularly Candida species, and the importance of prompt diagnosis and appropriate treatment.

摘要

尽管引起肠道穿孔和坏死的真菌感染很罕见,但在免疫抑制患者中可能特别危险,常常导致死亡率增加和预后不良。念珠菌属通常是体表真菌,但在免疫系统受损的患者中,它们可侵入小肠并引起血管侵袭性感染。一项涉及一名30岁急性髓系白血病(AML)女性患者的病例研究说明了这一现象。该患者出现腹痛、发热、腹泻、反复肠道坏死发作、血小板减少导致的血肿以及术后肠皮肤瘘等症状。广泛检查排除了肠道坏死和肠炎的其他可能原因,包括克罗恩病和巨细胞病毒疾病。最终在来自外周血、腹腔液和相关部位肠道活检的血培养中鉴定出[具体真菌名称未给出],表明它是导致肠道侵袭和坏死的原因。然后该患者接受了两性霉素B、头孢吡肟和甲硝唑治疗。这个病例突出了免疫抑制患者中真菌感染,尤其是念珠菌属感染的潜在严重性,以及及时诊断和适当治疗的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c2a3/11286315/579072f1f20f/CRIID2024-7806235.001.jpg

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